By Elena Grebenciucova, MD, as told to Keri Wiginton
When I think about how far we’ve come in treating relapsing-remitting multiple sclerosis (MS), it’s incredible.
In the 1990s, MS medications were modestly effective at best. Now we have treatments that can dramatically change the course of the disease by preventing new symptoms and lesions and lowering the risk of long-term disability.
As a neurologist with Northwestern Medicine in Chicago, I see it every day. People who were once terrified by their diagnosis are now thriving. They’re working, traveling, starting families, and living the lives they dreamed. That’s what modern MS care looks like.
But progress doesn’t mean it’s always easy. Each person’s journey comes with decisions, doubts, and practical realities. These are the challenges I see most often in my clinic and how we tackle them together.
Starting Treatment Early
One of the most important lessons we’ve learned about MS is that timing matters. Starting a highly effective disease-modifying therapy (DMT) early, ideally within the first year or two after diagnosis, gives people the best chance to stay stable long term.
Studies that follow people for 10 to 15 years show that those who begin treatment early have fewer relapses, fewer new lesions, and less disability over time.
What these medications can’t do is reverse damage that’s already happened. If inflammation has caused weakness, numbness, or vision loss, those symptoms may not fully go away.
Still, starting treatment right away can feel like a big step. Some people may have only had one attack, such as optic neuritis, where vision becomes blurry and then improves. When you’re feeling back to normal, it’s hard to see why medication is needed. I understand that hesitation.
A single relapse affecting the spinal cord can lead to lasting weakness or balance problems. And even when there are no symptoms, new “silent” lesions can still form in the brain. These don’t cause immediate problems, but over time they can affect thinking, mood, or coordination.
That’s why early action is so important. We want to calm inflammation before it causes irreversible damage in the brain or spinal cord. I always remind my patients that treatment isn’t about how you feel today. It’s about protecting your future self.
Finding the Right Treatment for You
There’s no one-size-fits-all approach to treating MS. The best plan is one that’s both effective and doable for you.
When I meet someone newly diagnosed, we review their personal preferences and risk factors for side effects. Do they have diabetes, liver, or kidney problems? Do they travel often or need certain vaccines? Do they want to give themselves a shot at home? Or do they want to get an infusion at the clinic?
I also go over the different types of DMTs. Some simply keep immune cells from entering the brain and spinal cord, while others suppress certain immune cells to quiet inflammation. The more aggressive treatments can be highly effective but may slightly raise the risk of infection.
Over time, your needs may change and so might your treatment. If something isn’t working or feels too hard to manage, we revisit the plan. The goal is always to find a treatment that keeps the disease quiet while still fitting into your life.
The goal is a shared decision that fits both medically and personally. When a therapy aligns with someone’s life, they’re more likely to stay consistent. And that consistency is what protects the brain and spinal cord long term.
Managing Fears About Side Effects
Understandably, people are cautious about new medications. When you read about possible side effects online, it can sound overwhelming. Even for doctors, those lists can look alarming if you don’t have context.
But for the vast majority of people on modern DMTs, day-to-day life feels completely normal. These are not chemotherapy drugs. They don’t cause hair loss or severe nausea. The most common issues are mild, like fatigue after an infusion or redness where a shot was given.
A few therapies slightly increase infection risk, so we monitor lab results and make sure vaccinations are up-to-date when safe. With regular follow-up, we can address nearly all side effects before they become a problem.
Switching Treatments Safely
Sometimes the first MS treatment you start isn’t the one you’ll stay on. With most highly effective DMTs, especially the B-cell-depleting drugs, it’s fairly easy to switch between options like infusions and shots based on what works best for you.
There is one monthly infusion medication that’s different. Once someone switches from it to a B-cell-depleting treatment, it’s not safe to go back. That’s because certain safety tests, like the JCV antibody test used to monitor infection risk, can become unreliable after switching.
Some medications need a washout period. That means they must clear from your system before you start another. Others need to be replaced quickly to avoid a rebound MS attack.
The key is working closely with your doctor. Careful planning helps keep your treatment effective and reduces unnecessary risks.
Navigating Treatment Costs
Cost can be a barrier to consistent care. Even with insurance, about 15%-20% of people in my practice experience coverage issues at some point.
When that happens, my team and I help right away. We submit appeals, speak with insurance reviewers, and connect patients with assistance programs run by drug companies or nonprofit groups.
The National MS Society is also a valuable resource. They maintain up-to-date lists of financial aid programs and can connect people with specialists who know how to navigate insurance systems.
If you have trouble paying for your medicine, please let your MS team know. There’s almost always a way to get some or all your costs covered, but we can only help if we know you need support.
Getting the Best MS Care
If you’re not sure you’re on the best treatment, it’s always OK to ask questions or get a second opinion. Start with your current neurologist, but if you’re not being seen at an MS clinic, consider visiting one.
An MS clinic is a specialized center led by fellowship-trained neuroimmunologists who focus solely on multiple sclerosis and related diseases.
These clinics take a comprehensive approach to care. We don’t just look at MRI scans and relapses. We also check on things like memory and thinking, bladder function, muscle stiffness, mood, and sleep.
We often work closely with other specialists, including psychiatrists for anxiety or depression, sleep neurologists for insomnia or sleep apnea, neuro-urologists for bladder problems, and neuro-ophthalmologists for vision issues. It’s truly a team effort.
The benefit of being seen at an MS center is that you’re working with doctors who treat thousands of people with MS and stay current with the latest research and therapies.
To find an MS clinic near you, visit NationalMSSociety.org and search for providers by ZIP code or state. You can also check your nearest academic medical center. Many have dedicated MS programs that offer this kind of coordinated care.
What’s Ahead for MS Treatment
The next decade of MS care will likely bring new and more targeted options. Researchers are studying advanced immune therapies like CAR T-cell treatment and stem cell transplants, both of which aim to reset the immune system and stop the disease more completely.
There’s also growing excitement around BTK inhibitors. Those are a new class of drugs designed to target inflammation more precisely. And one of the most important areas of research focuses on remyelination or repairing the nerve coating that MS damages.
The future of MS treatment is no longer just about preventing relapses. It’s about stopping disease activity and, eventually, repairing what’s been lost.
Looking Ahead With Confidence
When I meet someone newly diagnosed with relapsing-remitting MS, I tell them we’re in a completely different era of treatment. With modern therapies, most people can stay stable for many years and live full, active lives.
At follow-up visits, my patients often tell me they’re doing well and have no new symptoms. Many are back to work and pursuing goals they once thought might not be possible.
When RRMS is diagnosed early and treated promptly with medication that works well, it doesn’t have to be the life-altering condition people once feared. Today’s highly effective treatments have truly changed what living with MS can look like.
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SOURCES:
Elena Grebenciucova, MD, neuroimmunologist, Regenstein Center for Neurological Care, Northwestern Medicine; assistant professor of neurology, Northwestern University Feinberg School of Medicine.
